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Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and Clostridioides difficile infection

Published online by Cambridge University Press:  29 May 2020

Julia E. Szymczak Open the ORCID record for Julia E. Szymczak [Opens in a new window] ,
Brandi M. Muller ,
Nikitha Shankar Shakamuri ,
Keith W. Hamilton ,
Jeffrey S. Gerber ,
Maryrose Laguio-Vila ,
Ghinwa K. Dumyati ,
Scott K. Fridkin ,
Alice Y. Guh  and
Sujan C. Reddy
...Show all authors
Julia E. Szymczak*
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Brandi M. Muller
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Nikitha Shankar Shakamuri
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Keith W. Hamilton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Maryrose Laguio-Vila
Affiliation:
Department of Infectious Diseases, Rochester General Hospital, Rochester, New York
Ghinwa K. Dumyati
Affiliation:
Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York New York Emerging Infections Program, Rochester, New York
Scott K. Fridkin
Affiliation:
Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
Alice Y. Guh
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, AtlantaGeorgia
Sujan C. Reddy
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, AtlantaGeorgia
Ebbing Lautenbach
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Julia E. Szymczak, E-mail: jszymcza@pennmedicine.upenn.edu
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Abstract

Background:

Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.

Methods:

We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.

Results:

Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.

Conclusions:

Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 914 - 920
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: The findings of this study were presented as an oral abstract (no. 474) at the 2019 Society for Healthcare Epidemiology (SHEA) Spring Conference on April 25, 2019, in Boston, Massachusetts.

References

Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2019.Google Scholar
Magill, SS, O’Leary, E, Janelle, SJ, et al.Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med. 2018;379:1732–1744.CrossRefGoogle Scholar
Brown, KA, Langford, B, Schwartz, KL, Diong, C, Garber, G, Daneman, N. Antibiotic prescribing choices and their comparative C. difficile infection risks: a longitudinal case-cohort study. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa124.CrossRefGoogle ScholarPubMed
Kuntz, JL, Chrischilles, EA, Pendergast, JF, Herwaldt, LA, Polgreen, PM. Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis 2011;11:194.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66(7):e1–e48.CrossRefGoogle Scholar
Kazakova, SV, Baggs, J, McDonald, LC, et al.Association between antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2006–2012: an ecologic analysis. Clin Infect Dis 2020;70:11–18.CrossRefGoogle ScholarPubMed
Dancer, SJ, Kirkpatrick, P, Corcoran, DS, Christison, F, Farmer, D, Robertson, C. Approaching zero: temporal effects of a restrictive antibiotic policy onhospital-acquired Clostridium difficile, extended-spectrum beta-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2013;41:137–142.CrossRefGoogle ScholarPubMed
Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile–associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45 suppl 2:S112–S121.CrossRefGoogle ScholarPubMed
Aldeyab, MA, Kearney, MP, Scott, MG, et al.An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. J Antimicrob Chemother 2012;67:2988–2996.CrossRefGoogle ScholarPubMed
Talpaert, MJ, Gopal Rao, G, Cooper, BS, Wade, P. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:2168–2174.CrossRefGoogle ScholarPubMed
Shea, KM, Hobbs, ALV, Jaso, TC, et al.Effect of a health care system respiratory fluoroquinolone restriction program to alter utilization and impact rates of Clostridium difficile infection. Antimicrob Agents Chemother 2017;61(6):e00125–17.CrossRefGoogle ScholarPubMed
Dingle, KE, Didelot, X, Quan, TP, et al.Effects of control interventions on Clostridium difficile infection in England: an observational study. Lancet Infect Dis 2017;17:411–421.CrossRefGoogle ScholarPubMed
Feazel, LM, Malhotra, A, Perencevich, EN, Kaboli, P, Diekema, DJ, Schweizer, ML. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:1748–1754.CrossRefGoogle ScholarPubMed
Charani, E, Edwards, R, Sevdalis, N, et al.Behavior change strategies to influence antimicrobial prescribing in acute care: a systematic review. Clin Infect Dis 2011;53:651–662.CrossRefGoogle ScholarPubMed
Rzewuska, M, Charani, E, Clarkson, JE, et al.Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper. Clin Microbiol Infect 2019;25:163–168.CrossRefGoogle ScholarPubMed
Charani, E, Holmes, A. Antibiotic stewardship-twenty years in the making. Antibiotics (Basel). 2019;8(1):7.CrossRefGoogle Scholar
Werner, NL, Hecker, MT, Sethi, AK, Donskey, CJ. Unnecessary use of fluoroquinolone antibiotics in hospitalized patients. BMC Infect Dis 2011;11:187.CrossRefGoogle ScholarPubMed
Braykov, NP, Morgan, DJ, Schweizer, ML, et al.Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis 2014;14:1220–1227.CrossRefGoogle Scholar
Fridkin, S, Baggs, J, Fagan, R, et al.Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep 2014;63:194–200.Google ScholarPubMed
Salsgiver, E, Bernstein, D, Simon, MS, et al.Knowledge, attitudes, and practices regarding antimicrobial use and stewardship among prescribers at acute-care hospitals. Infect Control Hosp Epidemiol 2018;39:316–322.CrossRefGoogle ScholarPubMed
Broom, A, Kirby, E, Gibson, AF, Post, JJ, Broom, J. Myth, manners, and medical ritual: defensive medicine and the fetish of antibiotics. Qual Health Res 2017;27:1994–2005.CrossRefGoogle ScholarPubMed
Broom, J, Broom, A, Kirby, E. The drivers of antimicrobial use across institutions, stakeholders and economic settings: a paradigm shift is required for effective optimization. J Antimicrob Chemother 2019;74:2803–2809.CrossRefGoogle ScholarPubMed
Nichter, M, Vuckovic, N. Agenda for an anthropology of pharmaceutical practice. Soc Sci Med 1994;39:1509–1525.CrossRefGoogle ScholarPubMed
Krockow, EM, Colman, AM, Chattoe-Brown, E, et al.Balancing the risks to individual and society: a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals. J Hosp Infect 2019;101:428–439.CrossRefGoogle ScholarPubMed
Szymczak, JE, Newland, JG. The social determinants of antimicrobial prescribing: Implications for antimicrobial stewardship. In: Barlam, TF, Neuhauser, MM, Tamma, PD, Trivedi, K, eds. Practical Implementation of an Antimicrobial Stewardship Program. Cambridge, UK: Cambridge University Press; 2018:45–62.CrossRefGoogle Scholar
Weiss, RS. Learning from Strangers: The Art and Method of Qualitative Interview Studies. New York: The Free Press; 1994.Google Scholar
Malterud, K, Siersma, VD, Guassora, AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2016;26:1753–1760.CrossRefGoogle ScholarPubMed
Birks, M, Chapman, Y, Francis, K. Memoing in qualitative research. J Res Nurs 2008;13(1):7.CrossRefGoogle Scholar
Kerr, C, Nixon, A, Wild, D. Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Rev Pharmacoecon Outcomes Res 2010;10:269–281.CrossRefGoogle ScholarPubMed
NVivo 12 software. QSR International. Doncaster, Australia; 2018.Google Scholar
Deterding, NM, Waters, MC. Flexible coding of in-depth interviews: a twenty-first-century approach. Sociol Method Res 2018. doi: 10.1177/0049124118799377.CrossRefGoogle Scholar
Gale, NK, Heath, G, Cameron, E, Rashid, S, Redwood, S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013;13:117.CrossRefGoogle ScholarPubMed
Livorsi, D, Comer, A, Matthias, MS, Perencevich, EN, Bair, MJ. Factors influencing antibiotic-prescribing decisions among inpatient physicians: a qualitative investigation. Infect Control Hosp Epidemiol 2015;36:1065–1072.CrossRefGoogle ScholarPubMed
Livorsi, D, Comer, AR, Matthias, MS, Perencevich, EN, Bair, MJ. Barriers to guideline-concordant antibiotic use among inpatient physicians: a case vignette qualitative study. J Hosp Med 2016;11:174–180.CrossRefGoogle ScholarPubMed
Laake, AM, Bernabe, G, Peterson, J, Liappis, AP. Internal medicine resident perspectives regarding broad-spectrum antibiotic usage. Open Forum Infect Dis 2017;4(2):ofx060–ofx060.CrossRefGoogle ScholarPubMed
Om, C, Daily, F, Vlieghe, E, McLaughlin, JC, McLaws, ML. “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control 2016;5:58.CrossRefGoogle ScholarPubMed
Broom, A, Broom, J, Kirby, E. Cultures of resistance? A Bourdieusian analysis of doctors’ antibiotic prescribing. Soc Sci Med 2014;110:81–88.CrossRefGoogle ScholarPubMed
Broom, J, Broom, A, Kirby, E, Gibson, AF, Post, JJ. Individual care versus broader public health: a qualitative study of hospital doctors’ antibiotic decisions. Infect Dis Health 2017;22:97–104.CrossRefGoogle ScholarPubMed
Faure, H, Leguelinel-Blache, G, Salomon, L, Poujol, H, Kinowski, JM, Sotto, A. Assessment of patient adherence to anti-infective treatment after returning home. Med Mal Infect 2014;44:417–422.CrossRefGoogle ScholarPubMed
Eells, SJ, Nguyen, M, Jung, J, Macias-Gil, R, May, L, Miller, LG. Relationship between adherence to oral antibiotics and postdischarge clinical outcomes among patients hospitalized with Staphylococcus aureus skin infections. Antimicrob Agents Chemother 2016;60:2941–2948.CrossRefGoogle ScholarPubMed
Falagas, ME, Karagiannis, AK, Nakouti, T, Tansarli, GS. Compliance with once-daily versus twice or thrice-daily administration of antibiotic regimens: a meta-analysis of randomized controlled trials. PLoS One 2015;10(1):e0116207.CrossRefGoogle ScholarPubMed
Ewers, T, Knobloch, MJ, Safdar, N. Antimicrobial stewardship: the role of the patient. Curr Treatment Options Infect Dis 2017;9:92–103.CrossRefGoogle Scholar
Vaughn, VM, Gandhi, T, Conlon, A, Chopra, V, Malani, AN, Flanders, SA. The association of antibiotic stewardship with fluoroquinolone prescribing in Michigan hospitals: a multi-hospital cohort study. Clin Infect Dis 2019;69:1269–1277.CrossRefGoogle ScholarPubMed
Vaughn, VM, Linder, JA. Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care. BMJ Qual Saf 2018;27:583–586.CrossRefGoogle ScholarPubMed
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